Provider Demographics
NPI:1508890609
Name:OLSON, BRYCE HARVEY (PT)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:HARVEY
Last Name:OLSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BRIERCROFT OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-3011
Mailing Address - Country:US
Mailing Address - Phone:806-795-7433
Mailing Address - Fax:806-795-7407
Practice Address - Street 1:25 BRIERCROFT OFFICE PARK
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-3011
Practice Address - Country:US
Practice Address - Phone:806-795-7433
Practice Address - Fax:806-795-7407
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83721EMedicare ID - Type Unspecified